Open AccessNonmydriatic Fundus Photography in Patients with Acute Vision Loss
Author(s) -
Caroline Vasseneix,
Bonnie Bruce,
Samuel Bidot,
Nancy J. Newman,
Valérie Biousse
Publication year - 2019
Publication title -
telemedicine and e-health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.951
H-Index - 73
eISSN - 1556-3669
pISSN - 1530-5627
DOI - 10.1089/tmj.2018.0209
Subject(s) - medicine , triage , fundus photography , referral , emergency department , ophthalmology , fundus (uterus) , medical diagnosis , neuro ophthalmology , optometry , glaucoma , visual acuity , emergency medicine , fluorescein angiography , family medicine , pathology , psychiatry
Background: Acute visual loss is a common chief complaint in emergency department (ED) patients, but the scarcity of ophthalmologists in most EDs limits its evaluation. Introduction: Our objective was to evaluate whether nonmydriatic fundus photography (NMFP) in the ED helps triage patients with acute visual loss. Materials and Methods: We included 213 patients with acute visual loss evaluated in the ED with NMFP as part of the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED studies. Demographics, referral patterns, results of NMFP, and final diagnoses were recorded. Results: A final ophthalmological diagnosis was made in 109/213 (51%) patients. NMFP allowed a definite diagnosis in 51/109 (47%) patients: 14 nonglaucomatous optic neuropathies, 10 papilledema, 13 acute retinal ischemia, 2 retinal detachments, 2 choroidal metastases, 4 maculopathies, and 6 glaucoma. In 58/109 (53%) patients, NMFP was not diagnostic even when interpreted remotely by ophthalmologists due to disorders undiagnosable with NMFP. Ophthalmology consultation was requested in 109/213 (51%) patients, 41/54 (76%) patients with abnormal NMFP versus 68/159 (43%) patients with normal NMPF ( p < 0.001). Discussion: Although NMFP allowed rapid diagnosis in 51/213 (24%) patients presenting to the ED with acute visual loss, NMFP alone was not sufficient to detect all ocular diseases; ophthalmology consultation was more often requested when NMFP was abnormal. Conclusions: Our study emphasizes the limitations of teleophthalmology with NMFP in remotely detecting ocular diseases related to acute visual loss in the ED. NMFP helped triage and referral decisions and can be used to complement ophthalmology consultations in the ED.